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i I• � -"'.s ;� "-ate-"� \S APPLICATION FOR SANITATION PERMIT + (Complete in Duplicate). a Application is hereby made to the San Joaquin Local Health District for a permit to construct a d instal he work herein Bribed This application is made in compliance with County Ordinance No. 549. JOB ADDRESS A OCATION__-A�_,9-- _- Owner's Name-- t..�- ------ ------------------------------------- Phone------------------------------------- Address �- -- ------------------------------- ---------------------------------------- Contractor's Name_________ -------------------------- _ - ----- - -- - -- -------- ------- ------- ------- -------- ----------------- ----- Phone lnstallat -------------- ----------•------ ion will serve: Residence A arfinenf House E] Commercial ❑ Trailer Court E-] Motel El Other ❑ Number of living unifs.00 Number of bedrooms (Number of baths Lot size--- �_ a�Gf ' Water-Supply: Public s stem All------ y ❑ Community system ❑ "Private Character of soil to a depth of 3 feet: , Sand ❑ Gravel ❑ Sandy Loam E3"-ClayLa 1 oam ❑ Gy ❑ Adobe [] Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No'se`p'fic'fank or cesspool permitte -if d public sewer is available within 300 feet.) � a Septic Tank: Distance from nearest well-________________Distance from foundation-------------------.Material❑ No. of compartments--------------------------Capacity--__ Size--------------------------------Liquid depth--- -- Cesspgol: Distance from nearefst�rel�_- --------- ------Distance from oundafion-__ �----_-Lining material- _ _,� J`��( + Size: Diameter C �� D 'a=_-47�� - -- ------------------- eptly-----� Privy: Distance from nearest well_______________________-_ _ _ ___________________Distance from nearest buildin ❑ Distance to nearesf lot line----------------- g" """ ---- ------------ ------------------- -.Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- E Number of pits------ -----------------Lining material_________ --------------Size: Diameter------------------------Depth------------------- ' isposal Field: Distance from nearest well -________-".----Distance from foundation__.__________________Distance to nearest lot line N. ❑ Number of lines________________ ---------- -------Length of each line--------- _"______________ ------------------Width of trench------------ ' Type of filter material------------------------- material --------- - Remodeling and/or repairing (describe):-________------_---- a -----•----------- ------- ------------------------------- -- -----"- " ------------- ------------------------ ------- --------------------------------- 1 hereby certify that I have prepa ed this application and fha+ the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. l (Signed)---- ---- -- -- --- _ --�- ! ------- �. ..�.z, ---------------------- - (Owner and/or Contractor) lid $Y ---- --- ------------ --- -- -- (Title) - -- (Plot plans, showing sae of lot, location of system in relation to wells, buildings, etc., must be filed with this application]. FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY -__ - � --- ----------- DATE-------- :- REVIEWED BY ---------------------------------------- --------- - so*'.� - DATE --- _ BUILDING PERMIT ISSUED __ -------------------------------------------------------------------------------- ons and/ r recom endaf-ons:_- ----- .. . DA ------------ --- --- ------------------- --- - -- ---------------------------- -, --------------- ------------- ------------ ----- ------------ -7- --- --- Vis_--�--- - p / ------- -------------------- -- -------------------------------------------------------------------------- -- ------------------------------ t �P,ERMIT Ncr�'-T— -�6------ ISSUED------ --- -_3 s � _ _____________(Date) FINAL INSPECTIOgy �� 0 ".2-------------------------------Dafie_ = fU ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT_ 130 South American Street ES-9-2M 9-50 W-1639 }. Stockton, California f